Involving people in … Mental Health Services in east

June – July 2008

What's your preferred option for inpatient services in east Kent?

NHS and Social Care Partnership Trust Introduction The Kent and NHS and Social Care Partnership Trust is preparing to invest in the modernisation and improvement of some of its inpatient facilities in Margate, Ashford and . These inpatient services are focused mainly on the needs of people with dementia-related mental health problems. However, some of these hospital beds also cater for people with other mental health needs. These services are mainly used by older people, though they may be accessed by people of any age, whose needs would be best addressed in these environments. Before committing substantial resources to improving these environments, the Trust wants to understand the views of those people who may be affected by these changes themselves, or who care for others who may be affected. The Trust is also seeking the views of other partners and stakeholders prior to finalising its investment decision. Which areas are included in the review? Included in the review are the council areas of Ashford, Canterbury, Thanet, Shepway, (and Deal). Background In 2005 local health and social care agencies agreed a multi- agency strategy for providing mental health services to older people in particular. That strategy confirmed the principles that underpin the investments we are now planning. These are: 1) Services should be delivered as locally as possible, supporting and caring for individuals in their own home whenever possible. 2) Services should always be provided, according to need, to everyone who is eligible throughout our area. 3) Services should be efficient and demonstrate value for taxpayers’ money. 4) Most inpatient services for this group should be located on district general hospital sites as many older people with mental health problems also have physical problems which require access to diagnostic (eg x-ray, scan, etc) and other medical services. This is particularly true for people with dementia. Why are we planning these changes now? A significant amount of additional resources have been invested in community mental health services in the last two years, providing better support for service users and carers and enabling people to be cared for in their own homes. The most recent example is the home treatment service, which provides treatment for patients with dementia and includes specialist mental health professionals who can support and advise carers, enabling them to continue caring for their loved ones at home for longer. In line with the strategy agreed in 2005, the increased availability of community services means fewer inpatient beds are needed for this client group and, as a result, over recent years the number of inpatient beds has reduced in line with investments and community alternatives. The Trust believes that any further significant reduction in bed numbers is unlikely in the foreseeable future and so the time is right to ensure that those inpatient beds which remain in the system are provided in modern, fit for purpose environments. Furthermore, the beds currently located in the old hospital at St Martin’s were refurbished in 2005 and have a limited lifetime. To achieve this it was necessary to construct temporary buildings for which the City Council granted only temporary planning consent. This expires in 2010 and it is the Trust’s long-held intention to move out of these buildings, which are over 100 years old, by that date.

What is the situation at the moment? The inpatient environments we are planning to improve are currently situated on three sites: 1) The Arundel Unit, William Harvey Hospital Ashford (20 beds on Winslow Ward). 2) St Martin’s Hospital, Canterbury (45 beds on Ramsey, Cranmer and Edmund Wards). 3) Thanet Mental Health Unit, Queen Elizabeth The Queen Mother Hospital, Margate (26 beds on and Woodchurch Wards). The focus of this consultation is on these 91 beds, which are primarily used by older people with mental health needs. This document outlines the three different options for investment that the Trust is considering, alongside a further option known as the ‘do minimum’ option.

Options for change The Trust has carefully developed three different options for new investment. To do this a long list of all the available options was developed by a group of relevant stakeholders which were then rated against a set of criteria that had previously been agreed with service users and their carers, as well as a large number of mental health professionals. This work was supported by the local Primary Care Trust (PCT), which is responsible for commissioning services for the east Kent population. This exercise allowed the Trust to shortlist the options described in this document. Criteria for short-listing options for consultation Every option was tested against the following criteria: 1) Does the option provide locally accessible services? 2) Does the option support best practice/national guidance? 3) Does the option provide the best environment for the client group? 4) Does the option provide appropriate access to the range of services? Background to the options All mental health services should be provided to people on the basis of their needs and not determined solely by other factors such as, for example, age. However, significant numbers of older people with mental health problems also have a range of age- related, mainly physical, needs that make it sensible to provide care on a district general hospital site for the reasons referred to earlier. However, the Trust is keen to ensure that it provides a flexible mix of options for people who need to use its services and, for this reason, all three of the options for change include the relocation of 15 of the beds described above in the proposed new mental health unit at St Martin’s Hospital, which was agreed after public consultation in 2004. That new unit is due to be available from late 2010 onwards and it is the Trust’s intention to upgrade and modernise its remaining 76 mental health beds – the subject of this consultation – in broadly the same time scale. Feedback Form

Over to you…… 1 Which of the four options you think is the most appropriate for people who need inpatient treatment. Please tick which option you prefer.

Option 1 Option 2 Option 3 Option 4

Please explain why you think this is the best option. (Continue on a separate piece of paper if necessary.)

2 If you have experience of older people’s mental health care in the community, do you consider that the service user has sufficient support for their needs? Please tick one

Yes Mostly No

3 If you are a carer do you consider that you get enough support for your own needs? Please tick one

Yes Mostly No

4 If you have answered no to either question 2 or 3 please tell us what extra support you feel you would like to receive, and give any suggestions for service improvement

5Areyou: Acarer A service user

A representative of a group A member of the public

6 Please give your postcode

Thank you for taking the time to respond to the above questions we value your input greatly. We are committed to developing services to meet your needs and the needs of future service users. Please detach this response form and post it to us.There is no need for an envelope or a stamp. Business Reply Plus Licence Number RRTH-AATU-CYUA

Eastern and Coastal Kent PCT Brook House Reeves Way CT5 3SS Options

The options for the remaining 76 beds in the service, therefore, are as follows: Option 1

Three units providing mental health inpatient services located on the three district general hospital sites in East Kent as follows: 31 beds on two wards at the Queen Elizabeth the Queen Mother Hospital, Margate. 30 beds in two wards at the Arundel Unit, William Harvey Hospital, Ashford. 15 beds in a new mental health unit on the Kent and Canterbury site in Canterbury. Option 2

Two units providing mental health inpatient services on two district general hospital sites at opposite ends of the East Kent area as follows: 46 beds on three wards at the Thanet Mental Health Unit at the Queen Elizabeth the Queen Mother Hospital, Margate. 30 beds on two wards at the Arundel Unit, William Harvey Hospital, Ashford. Option 3

Three units providing mental health inpatient services (two on district general hospital sites and one on a mental health site) as follows: 31 beds in the Thanet Mental Health Unit at the Queen Elizabeth the Queen Mother Hospital, Margate. 15 beds in a Mental Health Unit at St Martin’s Hospital, Canterbury. 30 beds in the Arundel Unit, William Harvey Hospital, Ashford. As stated above, all three of these options are in addition to the 15 beds that will be provided in the new unit at St Martin’s Hospital in 2010. Option 4

This is what is known as the ‘do minimum’ option and would involve changing as little as possible in the current arrangements, while focusing investment on meeting minimum standards throughout the service. Summary

In all options it is proposed to increase beds at the Arundel Unit in Ashford. In all options it is proposed to provide 15 of the existing 91 beds in the new unit proposed for St Martin’s in 2010. The main differences between the options are that:

In option 1): 15 beds for the Canterbury population are provided in a new unit on the Kent and Canterbury site. In option 2): 15 beds would be provided in Thanet (totalling 46 beds) at the Queen Elizabeth The Queen Mother Hospital site. In option 3): 15 beds would be provided in a separate mental health unit at St Martin’s Hospital, Canterbury. The options will obviously differ in terms of investment levels, in terms of local access and in terms of the location of 15 beds for the Canterbury population. The purpose of this consultation is to gather interested parties’ views on each of these options so that the Trust can take account of these in confirming its investment decisions. That decision will also be informed by independently conducted financial and non-financial appraisals due to take place during the consultation period. The Trust Board hopes to make its decision in the early autumn of 2008. How can you be involved? You are being invited to become involved in this review because the decision to be made can potentially affect all of us at some time in our lives – either as a relative, a carer, or as a patient. Please read and carefully consider the details in this consultation leaflet about the proposals for Older Peoples Mental Health Services in eastern and coastal Kent. Kent and Medway Partnership Trust would like to find out from you what is working well, what needs to be improved and which of the four options you favour. Having read the information in the leaflet, please answer the questions in the Feedback Form. Once completed, detach it from the leaflet and send it to the address on the reverse of the form. The response form is self-addressed and there is no need for a stamp. All responses will be collated and taken into account when the final decisions are being made. If you would like any further information in respect of this review, you will find details of a series of meetings to discuss its implications on our website at www.kmpt.nhs.uk/ekmhredesign. If you would like to organise your own group meeting to discuss these issues in more detail, please contact: Communications Department, Trust Headquarters, 35 King’s Hill Avenue, King’s Hill, , Kent ME19 4AX. Email: [email protected], or phone 01732 520441 and we will do all we can to arrange a meeting with your group.